This application, a translational component of a U01 Consortium of UMMS, Cleveland Clinic, UTSouthwestern and U Louisville, explores novel therapies and biomarker discoveries in AH. Direct effects of alcohol on hepatocytes, increased intestinal permeability and activation of the innate immune system (Kupffer cells) by gut-derived LPS are major factors in AH leading to over-activation of the pro-inflammatory cascade. Currently, there are no effective strategies in AH. Our data in a mouse model demonstrated that deficiency of IL-1R or inhibition of IL-1R signaling by administration of an IL-receptor antagonist significantly attenuated steatosis and inflammatory cytokine induction in alcoholic liver disease. We also identified that microRNA-155 is an alcohol-induced regulator of increased Kupffer cell activation and TNF production in ALD. Furthermore, increased circulating levels of microRNAs correlated with liver injury and inflammation identifying them as potential biomarkers. The aims of this U01 application are to 1) evaluate novel therapeutic targets to attenuate inflammation in AH using bench-to-bedside approaches, and to 2) identify unique biomarkers for diagnostic and therapeutic decisions in AH. The following Aims will be investigated: Aim #1: To identify and validate novel biomarkers of AH associated with mild-moderate and severe disease and response to therapy by exploring a) circulating microRNAs as markers of mild-moderate and severe AH and/or response to therapy, b) TLR4 tolerance in monocytes as a biomarker of disease severity and/or response to therapy and c) circulating unique biomarkers of systemic inflammation, gut permeability, liver injury and regeneration. Aim #2: To test IL-1 inhibition as a novel therapeutic strategy in alcoholic hepatitis using translational approaches. Aim #3: To identify unique new drug targets for treatment of AH using a translational approach to test Farnesoid X Receptor agonists and miRNA-155 inhibition in preclinical studies.